Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
J Vasc Surg. 2011 Jul;54(1):123-31. doi: 10.1016/j.jvs.2010.12.039. Epub 2011 Mar 2.
This study examined the association between alcohol use, the occurrence of cardiovascular events, and plaque phenotype in patients after femoral or carotid endarterectomy for arterial occlusive disease. Alcohol has been shown to have cardiovascular protective effects in patients with cardiovascular disease as well as in healthy individuals. Whether alcohol consumption induces changes in atherosclerotic plaque composition has not been investigated.
Consecutive femoral (n = 224) and carotid (n = 693) endarterectomy specimens underwent histologic examination for the presence of collagen, calcifications, smooth muscle cells, macrophages, fat, and intraplaque thrombus. Patients were monitored for 3 years after the initial operation and investigated for the occurrence of cardiovascular events. Primary outcome was the composite end point "major cardiovascular event." Alcohol consumption was categorized as no alcohol use, 1 to 10 U/wk, or >10 U/wk.
The Kaplan-Meier estimate of the major cardiovascular event rate after 3 years of follow-up in the femoral group was 35% for no alcohol use and 21% for 1 to 10 U/wk, whereas only 10% of the group >10 U/wk sustained a major cardiovascular event (P = .010). The plaques of alcohol consumers in the femoral group contained significantly smaller lipid cores and less macrophage infiltration than in abstainers. In the carotid group, the major cardiovascular event rate was similar in all three groups, and in addition, no difference in plaque composition was observed.
This study shows an inverse relationship between alcohol use and major cardiovascular events after endarterectomy for lower extremity arterial occlusive disease, accompanied by a more stable plaque phenotype. However, no such relationship could be observed for patients with cerebrovascular disease.
本研究旨在探讨酒精使用与股动脉或颈动脉内膜切除术治疗动脉闭塞性疾病患者发生心血管事件及斑块表型之间的关系。已有研究表明，酒精对心血管疾病患者和健康人群均具有心血管保护作用。然而，酒精摄入是否会引起动脉粥样硬化斑块成分的变化尚未得到研究。
连续对 224 例股动脉和 693 例颈动脉内膜切除术标本进行组织学检查，以确定胶原、钙化、平滑肌细胞、巨噬细胞、脂肪和斑块内血栓的存在。对患者进行 3 年的初始手术后监测，并调查心血管事件的发生情况。主要终点为“主要心血管事件”复合终点。酒精摄入量分为不饮酒、每周 1 至 10 单位和每周 >10 单位。
股动脉组患者在 3 年随访期间的主要心血管事件发生率的 Kaplan-Meier 估计值为不饮酒者为 35%，每周 1 至 10 单位者为 21%，而每周饮酒 >10 单位者仅为 10%（P =.010）。与不饮酒者相比，股动脉组中酒精使用者的斑块内脂质核心更小，巨噬细胞浸润程度更低。在颈动脉组中，三组之间的主要心血管事件发生率相似，而且未观察到斑块成分的差异。
本研究表明，下肢动脉闭塞性疾病患者行内膜切除术治疗后，与不饮酒者相比，饮酒与主要心血管事件呈负相关，且斑块表型更稳定。然而，在患有脑血管疾病的患者中，并未观察到这种关系。
